Systems and devices for anchoring sutures to bone are commonly used in medical or surgical operations. Anchored sutures are typically used to attach soft tissue, such as ligaments, tendons and muscles, to bone or inanimate objects, such as prostheses. The attachment may hold the tissue to a bone for an extended period of time to allow healing to occur. Alternatively, the attachment may be used to hold tissue in place temporarily during a surgical procedure to help perform or optimize that procedure.
Suture anchors typically have an anchor body, a suture attachment feature and a bone engaging feature for retaining the suture anchor within bone. The suture anchor may be inserted into a preformed hole in the bone, or with threaded (i.e., screw-type) suture anchors, the suture anchor may be screwed into the bone, with or without a preformed bore, in the manner of a common screw. Examples of suture anchors and suture anchor installation tools may be found in U.S. Pat. Nos. 4,946,468; 4,968,315; 5,002,550; 5,207,679; 5,217,486; 5,411,506; 5,411,523; 5,520,696; 5,522,845; 5,578,057 and 5,584,860.
Small suture anchors can be difficult to handle and manipulate with some existing suture anchor insertion tools. In particular, it can be difficult to retain a small suture anchor on the insertion tool until such time as the anchor is inserted into bone. Because of their small size, these suture anchors are difficult to reattach to the insertion tool in a surgical environment if they become prematurely separated from the insertion tool.
Suture management during and after insertion of the anchor can be challenging as well. Smaller suture anchors, which are often pre-loaded onto the insertion tool and pre-threaded with suture thread, must be managed to ensure that the anchors and any attached suture thread and needles are properly delivered to the surgical site.
One known approach to suture management is to carry the suture thread inside a cannulated suture anchor insertion tool, such as disclosed in U.S. Pat. Nos. 5,584,860, 5,411,506 and 5,258,016. This approach is sometimes used with threaded suture anchors so that the suture thread may be managed even while twisting the insertion tool to insert the threaded anchor. In some instances, and particularly with smaller suture anchors, the suture anchor mating area on the distal portion of the insertion tool is so small that it is difficult to pass suture needles therethrough. Thus, if needles are required for post-anchor installation suturing procedures, it can be difficult to deliver the needles to the surgical site with the insertion tool.
Other suture anchor insertion tools, such as the suture anchor insertion tool of U.S. Pat. No. 5,002,550, provide arcuate groove storage areas on the body of the tool where needles may be stored. A surgeon uses a tool, such as needle-nosed forceps, to remove the needles from the grooves.
Still other suture anchor insertion tools manage suture thread attached to the anchor by equipping the installation tool with external posts or surfaces, about which the suture thread is wound. The winding and unwinding of suture thread can also present surgical challenges when suture needles are pre-attached to the thread.
Perhaps as a result of the difficulties in managing suture thread, especially where needles are pre-attached to the thread, some existing suture insertion tools tend to be short, with the suture anchor being maintained very close to the handle portion of the tool. This can cause difficulties in minimally invasive surgical procedures where surgical tools are employed through small incisions in the patient's body, especially where such small incisions are not necessarily in immediate proximity to the preferred suture anchor insertion site.
There is thus a need for a suture anchor insertion tool that can deliver a small suture anchor to a bone attachment site through a small incision in the patient's body while maintaining the suture anchor on the tip of the tool and managing the suture thread and needles at the surgical site without the aforementioned drawbacks. The tool should be long enough to reach desired operative locations under minimally invasive, closed surgical conditions, should provide an efficient means to manage and tension the suture thread and should allow for easy management and delivery of suture needles to the desired site. In addition, the tool should be capable of delivering suture anchors and needles of a variety of sizes to the surgical site.